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324 Baier, Annette. 1985. Postures ofthe Mind: Essays on Mind and Morals. Mi of Minnesota Press. ,\ Callahan, Sidney. 1987. "A Pro-life Feminist Makes Her Case." Utne R,i 10 4-1 4. CARALIHalifax. 1990. Telling Our Stories: Abortion Stories from Nova Sco· Halifax (Canadian Abortion Rights Action League). Diamond, Irene, and Lee Quinby. 1988. "American Feminism and the Lang Feminism & Foucault: Reflections on Resistance. Edited by Irene Diamon Boston: Northeastern University Press. . Eisenstein, Zillah R. 1988. The Female Body and the Law. Berkeley: Univ, Press. Hoagland, Sara Lucia. 1988. Lesbian Ethics: Toward New Value. Palo Alto, C bian Studies. Lange, Lynda. 1983. "Woman is Not a Rational Animal: On Aristotle's Biol~, tion." In Discovering Reality: Feminist Perspectives on Epistemology, Metap ogy, and Philosophy of Science. Edited by Sandra Harding and Merill B. drecht, Holland: D. Reidel. Lerner, Gerda. 1986. The Creation of Patriarchy. New York: Oxford. Luker, Kristin. 1984. Abortion and the Politics ofMotherhood. Berkeley: Univer: Press. MacKinnon, Catherine. 1989. Toward a Feminist Theory ofthe State. Cambrid University Press. McDonnell, Kathleen. 1984. Not an Easy Choice: A Feminist Re-examines The Women's Press. Morgan, Kathryn Pauly. 1987. "Women and Moral Madness." In Science, Mo Theory. Edited by Marsha Hanen and Kai Nielsen. Canadian Journal ofP mentary Volume 13: 201-26. Murphy, Julien S. 1989. "Should Pregnancies Be Sustained in Brain-dead sophical Discussion of Postmortem Pregnancy." In Healing Technology. tives. Edited by Kathryn Srother Ratcliff et al. Ann Arbor: The University Overall, Christine. 1987. Ethics and Human Reproduction: A Feminist An MA: Allen & Unwin. Petchesky, Rosalind Pollack. 1980. "Reproductive Freedom: Beyond Choose.''' In Women: Sex and Sexuality. Edited by Catharine R. StimpsoJ} Person. Chicago: University of Chicago Press. '0 Sumner, L. W. 1981. Abortion and Moral Theory. Princeton: Princeton Univ, Thomson, Judith Jarvis. 1971. "A Defense of Abortion." Philosophy and Publ; Tooley, Michael. 1972. "Abortion and Infanticide." Philosophy and Public Affi 65·

Van Wagner, Vicki, and Bob Lee. 1989. "Principles into Practice: An Activist' Reproductive Health Care." In The Future of Human Reproduction. E Overall. Toronto: The Women's Press. [ Warren, Mary Anne. 1973. "On the Moral and Legal Status of Abortion." The _ _ _ .1989· "The Moral Significance of Birth." Hypatia, 4, 2 (Summer): 4 \'\Thitbeck, Carolyn. 1973. "Theories of Sex Difference." The Philosophi (Fall/Winter 1973-74): 54-80.

Section B: Procreative Technology and Procreative Freedom

The Meanings of Choice in Reproductive Technology Barbara Katz Rothman

ice and information have served as the cornerstones of the women's health and

roductive rights movements. We are, above all, pro-choice. We support the of the individual woman to choose, to choose pregnancy or abortion, to alternative medical treatments or none at all. And choice, we claim, rests on information: to choose treatment for breast cancer, for example, requires ation on the full range of medical treatments, their side effects, and their . ility of success. emphasis on choice and information all sounded very logical at the time, ed like women were going to get more and more control as first their access to ation and then their choices expanded. beginning to have second thoughts. ology is also about information, and about choice. More information on ·ngs work seems to give us more choices, new and better ways of doing things. true of the technology of transportation, which brings us cars and jets, and of chnology of reproduction, which brings us the Pill, amniocentesis and fetal ors. while technology opens up some choices, it closes down others. The new is often greeted with such fanfare that the silent closing of the door on the old goes unheeded. For example, is there any meaningful way one could now e horses over cars as a means of transportation? The new choice of a 'horseless ge' eventually left us 'no choice' but to live with the pollution and dangers (as s the conveniences and speed, of course) of a car-bas'ed fransportation system. roductive technology is heralded for its choice-giving capaCity. For those who ord it, the enormous growth of information about reproduction does make newly possible: the pregnant can choose whether or not to continue the preg-

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nancy, can even learn more about the fetus and then choose whether or not tinue; the infertile can choose new ways of attempting pregnancy; birthing can choose alternative ways of managing their labors and births. Choices ab want to look a bit at the negative side, though, look to see what, if any, cho being lost to us, going the way of the horse. Fetal monitoring is a good place to start. Fetal monitors, belts to go aro pregnant belly and electrodes to screw into the fetal head during labor, are a reproductive technology whose sole stated purpose is to bring more informa enable more and better choices. By knowing more about the condition of th during labor, more informed choice was to be possible for the management of bor. But some strange things happened. We didn't really get all that much rna formation than we had before-good nursing care always provided considerab formation about the fetus. It certainly did look like more information though those long strips of print-out. But more importantly, the information came in context. Instead of having to approach the woman, to rest your head near he to smell her skin, to feel her breathing, you could now read the information fetus from across the room, from down the hall. While still one being on medical personnel came to see the woman and fetus as separate, as two diffe tients. And indeed more choices could be made: the fetal heart rate indi distress-should the mother be sectioned? When a woman chooses to have a cesarean section because she is informe, fetal monitor indicates some distress, is she gaining or losing control? In answer is going to depend on the accuracy of the information. If medical ners are overly quick to read fetal distress, as they have been, then the loss Q is clear. The woman is having major surgery, with all of its attendant ris health and life, making herself sick, weak and dependent as she enters mot But if the information is correct, and the fetus, her baby, is at risk and th could ensure its greater health, then she is gaining control over her mothe she makes this short-term sacrifice for the long-term health of her child. What happens when the woman and her medical practitioners disagree either about the accuracy of the information, or about the choice which made based on the information? What if a pregnant woman does not wan this sacrifice? Has all this new information expanded her choices? It seems. icine is once again turning to the state, as it has so many times in the p' medical choice ahead of women's choices. In several bedside Juvenile Court with a lawyer appointed to represent the unborn fetus, another represe pregnant woman, and yet others representing the hospital, women have los to choose, and have been ordered to submit to cesarean sections, the fe them claimed by the state as a 'dependent and neglected child'. (Hubbard, Thus information may expand the opportunity for choices, but it cert not guarantee whose choices will be honored. We thought that information would give us power. \"lhat we perhaps ove that it is power which gives one control over both information and choice:

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'he choice of contraception simultaneously closed down some of the choices for families. North American society is geared to small families, if indeed to any dren at all. Everything from car and apartment sizes the picture book ideal of "'es encourages limiting fertility. Without the provision of good medical care, care, decent housing, children are a luxury item, fine ifyou can afford them. So it choice all right that contraception gave us, and a choice we may very well experias being under our control, but it may be a somewhat forced choice. In its exe, legislation has been repeatedly introduced to punish 'welfare mothers' by cutoff payments if they have more children. Sterilization abuse is the flip side of the rtion battle: the same sorry record.... a there may be choice brought to us by information and technology, the choices get when we learn how to use contraception and back-up abortion for fertility trol, but the choices may very well be heavily weighted for, or against, us. oth the medical monitoring and management aflabor, and the use of contracepand abortion, are very well-established aspects of reproductive technologies; it t the specifics which keep changing, as newer techniques, machinery and chemget introduced. The next level of reproductive technology I want to address lbines fetal monitoring with fertility control to produce something new: 'quality 01: control not just of the number of children we bear, but of the 'quality' or ·tion of those children. niocentesis and sonography are the technologies which provide the informato make this new set of reproductive choices possible. Sonography, the use of d waves, allows the visualization of the fetus in utero, and the detection of gross ornical deformities. Amniocentesis is the withdrawal of a small amount of the 'otic fluid which surrounds the fetus. When done between the sixteenth and ieth weeks of pregnancy, the fetal cells in the fluid can be cultured and examOther tests can also be performed on the fluid. These techniques allow the di:is of many (under a hundred at this writing, but increasing all the time) genetic es and syndromes. Test results are available by the twenty-fourth week, the leit on abortion in the United States. If the fetus is found to have a terminal illike Tay Sachs disease which invariably kills in eary childhood), a severely incating condition (a syndrome which leads to such profound retardation that the ,ould be unable to learn to walk or to talk), a moderately disabling condition 'heekhair-bound or unable to walk without assistance), or a socially undesirndition (if, for example, the fetus is found to be of the 'wrong' sex, such as a If fourth daughter), a woman can use this infof};nation to choose an abortion. opening up Of choices and control with this te¢hnology is astounding. There Ufse, still no guarantee of a perfect baby-and even a perfect baby can be :erribly imperfect in accident or illness after birth-but one no longer need 'Wn syndrome, spina bifida or a host of other diseases and unwanted condiis of course begs the basic question of what makes any particular condition disabling or undesirable. Why Down syndrome, why daughters, why air-bound? But information is available, and information makes choice pos-

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sible. And it is the woman's choice. There may be pressure, subtle or p genetic counselors, doctors, family members, but it is still the woman to abort or not to abort. Or is it? When we have this information, when we make these choices for our we not then accepting responsibility for their condition, responsibility genuine control? If we choose not to abort a 'defenctive' fetus, and the lescent it becomes hurls at us, as adolescents so often have, 'I didn't ask whatever are we going to say now? Will our children be able to sue us fi life, as they have successfully sued their doctors? The doctors failed to pro formation which would have given the mothers the choice of abortion. mother who, given the information, chooses not to abort? Can she be he. ble for her child's condition, denied state services, insurance payments, with child abuse? And if we do choose to abort, is that truly a choice? What of the worn the fourth floor, walk-up apartment in a city designed without access abled-is her 'choice' to abort a fetus with spina bifida an exercise in free of the woman with few economic or family resources who chooses to a' with Down syndrome because she is fully and truly informed about the st which will be available to her child after her own death? It seems that, in gaining the choice to control the quality of our child be losing the choice notto control the quality, the choice of simply accep they are. There are ... genetic conditions ... about which we might be better 0 ing. XYY, the genetic condition which some studies suggested may be Ii inal behavior, is an example. The studies have been largely discredited, search shows there are women currently aborting XYY fetuses beca potential father said, 'It's hard enough to raise a normal kid. Ifhe throw: across the room will I think he's doing it because he's two, or because he What will happen as we get even more information, if we can begin to just retardation, but which fetuses are likely to become children of borde not just Tay Sachs, but which fetuses are likely to develop juvenile diabe information may be giving us choice, but is it coming any closer to giving And finally, briefly, what of the great expansion in the treatment of inti its choices? .. , All of the technology still leaves many couples, about a of those treated for infertility, without a pregnancy. At what point is it their fault, out of their control, inevitable, inexorable fate? At what point on with their lives? If there is always one more doctor to try, one mor, around, then the social role of infertility will always be seen in some sens they chose to give up. Did taking away the sense of inevitability of the' and substituting the 'choice' of giving up truly increase their choice an trol? There are those who are successful with the new technology, those for drugs and surgery are a success. Surely they have now experienced the cho

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od, and so their choices have expanded and they have gained control over their Indeed they have, just as contraception and abortion provide us with the very and very true experience of controlling our fertility. Choices open and choices For those whose choices meet the social expectations, for those who want what 'bciety wants them to want, the experience of choice is very real. rhaps what we should realize is that human beings living in society have prelittle choice ever. There may really be no such thing as individual choice in a structure, not in any absolute way. The social structure creates needs-the for women to be mothers, the needs for small families, the needs for 'perfect'
References ard, Ruth. 1982. 'Some Legal and Policy Implications of Recent Advances in Prenatal Dinasis and Fetal Therapy.' Women's Rights Law Reporter, Spring,? (3): 201-18.